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Although most infections are asymptomatic, a minority of carriers develop severe, life\u2010altering conditions: adult T\u2010cell leukemia\/lymphoma (ATL) or HTLV\u20101\u2010associated myelopathy\/tropical spastic paraparesis (HAM\/TSP). This narrative review presents a comprehensive analysis of epidemiological studies, clinical reports, and public health surveillance data. Data on HTLV\u20101 prevalence, incidence, clinical outcomes, proviral load associations, and public health measures were extracted and compared across major endemic and nonendemic regions. HTLV\u20101 exhibits extreme geographic heterogeneity. Hyperendemic foci include southwestern Japan (carrier population \u223c534,000 in 2020), parts of Brazil (estimated 800,000 carriers), the Caribbean (e.g., Jamaica, general population prevalence \u223c6.1%), and sub\u2010Saharan Africa (estimated 2\u20135 million infections, the largest global burden). In Central Australia, prevalence among Indigenous adults over 45 reaches 49.3%, the highest recorded regional rate globally. Prevalence varies significantly within populations: In Brazil, it is highest in the north\/northeast. In Gabon, rural prevalence is 8.7%, rising to 12.5% in rainforest provinces, with Pygmy ethnicity identified as an independent risk factor. In Iran, prevalence is concentrated in the northeast (2%\u20137%), whereas the rest of the country shows rates below 1%. In contrast, prevalence is very low in nonendemic areas such as the United States and most of Europe (&lt;\u20090.01% in Spain and Italy), except for Romania (5.3 per 10,000 donors) and areas with migrant populations. Incidence data are sparse but informative: In Japan, the annual incidence among blood donors is 6.88 per 100,000 person\u2010years for women and 2.29 per 100,000 person\u2010years for men. In the United Kingdom, the incidence of HAM\/TSP among HTLV\u20101 carriers is 1.98 per 1000 person\u2010years. A Brazilian cohort reported an HAM\/TSP incidence of 1.47% over 3\u2009years, substantially higher than Japan\u2019s lifetime risk of 0.25%. HTLV\u20101 remains a significant yet profoundly neglected global pathogen, exhibiting extreme geographic heterogeneity in prevalence, clinical outcomes, and transmission dynamics, driven by complex interactions of viral genetics, host factors, and disparities in public health infrastructure. Although proven cost\u2010effective interventions such as universal antenatal screening in Japan have demonstrably reduced transmission, the persistent \u201csilent\u201d spread in endemic, low\u2010resource regions particularly sub\u2010Saharan Africa and Indigenous Australia demonstrates a critical global health inequity demanding urgent, region\u2010specific strategies for screening, prevention, and patient care to mitigate its substantial burden of morbidity and mortality.<\/jats:p>","DOI":"10.1155\/cjid\/8667755","type":"journal-article","created":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T07:25:53Z","timestamp":1771831553000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Epidemiology and Clinical Outcomes of HTLV\u20101: A Comprehensive Narrative Review of Endemic and Nonendemic Regions"],"prefix":"10.1155","volume":"2026","author":[{"given":"Bezhan","family":"Noori","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-4727-4740","authenticated-orcid":false,"given":"Ramin","family":"Shahbahrami","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4202-4014","authenticated-orcid":false,"given":"Yousef","family":"Douzandegan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4570-2252","authenticated-orcid":false,"given":"Sayed-Hamidreza","family":"Mozhgani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3560-9508","authenticated-orcid":false,"given":"Mehdi","family":"Norouzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seyed Mohammad","family":"Jazayeri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,2,22]]},"reference":[{"key":"e_1_2_14_1_2","doi-asserted-by":"publisher","DOI":"10.3390\/v2092037"},{"key":"e_1_2_14_2_2","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.77.12.7415"},{"key":"e_1_2_14_3_2","doi-asserted-by":"publisher","DOI":"10.3390\/pathogens12050735"},{"key":"e_1_2_14_4_2","unstructured":"RendeF. 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